Factors That Influence Enrolment and Retention in Ghana’ National Health Insurance Scheme

Abstract Background: The government of Ghana introduced the National Health Insurance Scheme (NHIS) in 2004 with the goal of achieving universal coverage within 5 years. Evidence, however, shows that expanding NHIS coverage and especially retaining members have remained a challenge. A multilevel perspective was employed as a conceptual framework and methodological tool to examine why enrolment and retention in the NHIS remains low. Methods: A household survey was conducted after 20 months educational and promotional activities aimed at improving enrolment and retention rates in 15 communities in the Central and Eastern Regions (ERs) of Ghana. Observation, indepth interviews and informal conversations were used to collect qualitative data. Forty key informants (community members, health providers and district health insurance schemes’ [DHISs] staff) purposely selected from two casestudy communities in the Central Region (CR) were interviewed. Several community members, health providers and DHISs’ staff were also engaged in informal conversations in the other five communities in the region. Also, four staff of the Ministry of Health (MoH), Ghana Health Service (GHS) and National Health Insurance Authority (NHIA) were engaged in in-depth interviews. Descriptive statistics was used to analyse quantitative data. Qualitative data was analysed using thematic content analysis. Results: The results show that factors that influence enrolment and retention in the NHIS are multi-dimensional and cut across all stakeholders. People enrolled and renewed their membership because of NHIS’ benefits and health providers’ positive behaviour. Barriers to enrolment and retention included: poverty, traditional risk-sharing arrangements influence people to enrol or renew their membership only when they need healthcare, dissatisfaction about health providers’ behaviour and service delivery challenges. Conclusion: Given the multi-dimensional nature of barriers to enrolment and retention, we suggest that the NHIA should engage DHISs, health providers and other stakeholders to develop and implement intervention activities to eliminate corruption, shortage of drugs in health facilities and enforce the compulsory enrolment stated in the NHIS policy to move the scheme towards universal coverage

Exploring barriers to accessing physiotherapy services for stroke patients at Tema general hospital, Ghana

Abstract Background Physiotherapy has been shown to reduce the risk of disability among stroke patients. Poor adherence to physiotherapy can negatively affect outcomes and healthcare cost. However, very little is known about barriers especially to physiotherapy services in Ghana. The objective of this study was to assess the barriers to physiotherapy services for stroke patients at Tema General Hospital (TGH). The individual/personal and health system barriers to physiotherapy services at TGH were determined. Method A cross-sectional study design was employed. A simple random sampling technique was used to recruit 207 respondents for a face-to-face interview. Interviewer-administered questionnaires were used to collect data on individual/personal barriers of respondents to physiotherapy services and were described using the Likert’s scale. Health system barriers were assessed using a self-structured questionnaire which had section under the following heading: human factors, physiotherapy modalities, physical barriers and material/equipment factors. The time spent waiting for physiotherapy and attitude of physiotherapist towards patients; physiotherapy modality such as electrotherapy, exercise therapy and massage therapy among others were some of the indices measured. Respondents’ adherence to Medication was assessed with the Morisky 8-item medication adherence questionnaire. Data were entered and analysed using Epi info 7 and STATA 12.0. Associations between the variables were determined using a chi-square test and logistic regression model was used to test the strength of associations between the independent and the dependent variables. The level of statistical significance was set at p < 0.05. Results The results showed that majority (76.3%) of the respondents had economic barrier as their main individual/personal barrier to physiotherapy services. For medication adherence level, patients with low medication adherence level were about 21 times the odds of defaulting on accessing physiotherapy services five times or more as compared to those with medium adherence level (OR 20.63, 95% CI 8.96, 42.97). It was concluded in the study that individual/personal barriers of stroke patients were the significant barriers to accessing physiotherapy services at Tema General Hospital

Predictors of self-reported health among the elderly in Ghana: a cross sectional study

Abstract Background Self-reported health is a widely used measure of health status across individuals. As the ageing population increases, the health of the elderly also becomes of growing concern. The elderly go through life facing social, economic and financial hardships. These hardships are known to affect the health status of people as they age. The purpose of this study is to assess social and health related factors of self-reported health among the elderly in Ghana. Methods A multivariate regression analysis in form of a binary and ordinal logistic regression were used to determine the association between socioeconomic, demographic and health related factors, on self-reported health. The data used for this study was drawn from the World Health Organization (WHO) Study on Global Ageing and Adult Health (SAGE) Wave 1. Results In total, out of 2613 respondent, 579 (20.1%) rated their health status as poor and 2034 (79.9%) as good. The results showed that the odds of reporting poor health was 2.5 times higher among the old-old compared to the young old. The elderly with one or more than one chronic condition had the odds of 1.6 times and 2 times respectively, of reporting poor health. Engaging in mild to moderate exercise increased the chances of reporting poor health by 1.8 times. The elderly who had never worked in a lifetime were 2 times more likely to report poor health. In the same way, residents of Eastern and Western parts of Ghana were 2 times more likely to report poor health compared to those in the Upper West region. Respondents with functional limitations and disabilities were 3.6 times and 2.4 times respectively, more likely to report poor health. On the other hand, the odds of reporting poor health was 29, 36 and 27% less among respondents in the highest income quintiles, former users of tobacco and those satisfied with certain aspects of life respectively. Also, current alcohol users were 41% less likely to report poor health. Conclusion The health status of the elderly is to an extent determined by the circumstances in which they are born, grow and live. The findings suggest that addressing social issues faced by individuals in youthful age will go a long way to achieving good health in the future. People with physical limitations and disabilities are most vulnerable to unmet healthcare needs and support system from government, policy makers and family

Perspectives of frontline health workers on transition from development assistance for health in Ghana: A qualitative study.

Many Low-income countries depend on development assistance for health (DAH) to finance the health sector. The transition of these countries to middle-income status has led to reduction in effective aid from development partners while these countries are expected to graduate from global funding agencies such as Gavi the vaccine alliance, with implications for service delivery. The aim of this study was to explore the perspectives of frontline health workers regarding the implications of Ghana's transition to middle-income status on service delivery, the likely impact and opportunities it presents to the country. This exploratory qualitative study employed in-depth interviews to collect data from 16 health workers at three hospitals in the Greater Accra Region; one at the regional level and two at the district level. The study was conducted from December 2019 to July 2020. Data from interviews were transcribed, coded and analysed using thematic analysis in NVivo Qualitative Analysis Software version 12. The level of awareness among frontline workers about the transition and decline in DAH was generally low. Nonetheless, frontline health workers perceived that the country seems inadequately prepared for transition as donors continue to be major financiers for the sector and even for emergencies such as the current COVID-19 global pandemic. Potential challenges facilities would face due to transition may include difficulty in funding health programs, human resource challenges and delays in logistics and medicines. The implications for these will be poor health outcomes, defective monitoring and evaluation, and lapses in training programs. In addition, the perceived barriers to transition identified were poor management of resources, political interference and lack of technical expertise. While opportunities such as improvement of the health sector prioritization and efficiency, private sector involvement and autonomy could be gained. Gaps in the health intervention monitoring resulting from DAH transition could pose affect health outcomes, particularly in respect of HIV, tuberculosis and malaria. The country's preparedness to transition from DAH could be better improved with development of a clear transition plan agreed by stakeholders, including government and in-country development partners. For the health sector, the eligibility for DAH transition should not simply be based on economic growth, but importantly on a country's ability to sustain ongoing and upcoming health programs

Role of actor networks in primary health care implementation in low- and middle-income countries: a scoping review

Background Primary health care (PHC) improvement is often undermined by implementation gaps in low- and middle-income countries (LMICs). The influence that actor networks might have on the implementation has received little attention up to this point. Objective This study sought to offer insights about actor networks and how they support PHC implementation in LMICs. Methods We reviewed primary studies that utilised social network analysis (SNA) to determine actor networks and their influence on aspects of PHC in LMICs following the five-stage scoping review methodological framework by Arksey and O’Malley. Narrative synthesis was applied to describe the included studies and the results. Results Thirteen primary studies were found eligible for this review. Ten network types were identified from the included papers across different contexts and actors: professional advice networks, peer networks, support/supervisory networks, friendship networks, referral networks, community health committee (CHC) networks, inter-sectoral collaboration networks, partnership networks, communications networks, and inter-organisational network. The networks were found to support PHC implementation at patient/household or community-level, health facility-level and multi-partner networks that work across levels. The study demonstrates that: (1) patient/household or community-level networks promote early health-seeking, continuity of care and inclusiveness by enabling network members (actors) the support that ensures access to PHC services, (2) health facility-level networks enable collaboration among PHC staff and also ensure the building of social capital that enhances accountability and access to community health services, and (3) multi-partner networks that work across levels promote implementation by facilitating information and resource sharing, high professional trust and effective communication among actors. Conclusion This body of literature reviewed suggests that, actor networks exist across different levels and that they make a difference in PHC implementation. Social Network Analysis may be a useful approach to health policy analysis (HPA) on implementation

Economic cost and quality of life of family caregivers of schizophrenic patients attending psychiatric hospitals in Ghana

Abstract Background Low and middle income countries face many challenges in meeting their populations’ mental health care needs. Though family caregiving is crucial to the management of severe mental health disabilities, such as schizophrenia, the economic costs borne by family caregivers often go unnoticed. In this study, we estimated the household economic costs of schizophrenia and quality of life of family caregivers in Ghana. Methods We used a cost of illness analysis approach. Quality of life (QoL) was assessed using the abridged WHO Quality of Life (WHOQOL-BREF) tool. Cross-sectional data were collected from 442 caregivers of patients diagnosed with schizophrenia at least six months prior to the study and who received consultation in any of the three psychiatric hospitals in Ghana. Economic costs were categorized as direct costs (including medical and non-medical costs of seeking care), indirect costs (productivity losses to caregivers) and intangible costs (non-monetary costs such as stigma and pain). Direct costs included costs of medical supplies, consultations, and travel. Indirect costs were estimated as value of productive time lost (in hours) to primary caregivers. Intangible costs were assessed using the Zarit Burden Interview (ZBI). We employed multiple regression models to assess the covariates of costs, caregiver burden, and QoL. Results Total monthly cost to caregivers was US$ 273.28, on average. Key drivers of direct costs were medications (50%) and transportation (27%). Direct costs per caregiver represented 31% of the reported monthly earnings. Mean caregiver burden (measured by the ZBI) was 16.95 on a scale of 0–48, with 49% of caregivers reporting high burden. Mean QoL of caregivers was 28.2 (range: 19.6–34.8) out of 100. Better educated caregivers reported lower indirect costs and better QoL. Caregivers with higher severity of depression, anxiety and stress reported higher caregiver burden and lower QoL. Males reported better QoL. Conclusions These findings highlight the high household burden of caregiving for people living with schizophrenia in low income settings. Results underscore the need for policies and programs to support caregivers

Cost of inappropriate prescriptions for uncomplicated malaria in Ghana

Abstract Background Malaria remains a common course of morbidity in many sub-Saharan African countries. While treatment options have improved in recent times, inappropriate prescription seems conventional among providers, increasing the burden on patients and society. This study examined the cost of inappropriate prescriptions for uncomplicated malaria treatment in Ghana. Methods This study used retrospective data collected from January to December 2016 in 27 selected facilities, under different ownership in three regions of the country, mainly Volta, Upper East and Brong Ahafo. Stratified random sampling technique was used to extract 1625 outpatient folders of patients diagnosed and treated for malaria. Two physicians independently reviewed patient folders according to the stated diagnoses. Malaria prescriptions were described as inappropriate when they do not adhere to the standard treatment guidelines. The economic cost was mainly treatment cost which was sourced as medication cost. Total and average costs for country were calculated using sample estimates and the total number of uncomplicated malaria cases that received inappropriate prescriptions. Results The study revealed that patients received an average of two prescriptions per malaria episode. Artemether-lumefantrine (AL) was the major malaria medication (79.5%) prescribed to patients. Other medications usually antibiotics and vitamins and minerals were included in the prescription. More than 50% of prescribers did not follow the guidelines for prescribing medications to clients. By facility type, inappropriate prescription was high in the CHPS compounds (59.1%) and by ownership, government (58.3%), private (57.5%) and mission facilities (50.7%). Thus, about 55% of malaria prescriptions were evaluated as inappropriate during the review period, which translates into economic cost of approximately US$4.52 million for the entire country in 2016. The total cost of inappropriate prescription within the study sample was estimated at US$1,088.42 while the average cost was US$1.20. Conclusion Inappropriate prescription for malaria is a major threat to malaria management in Ghana. It presents a huge economic burden to the health system. Training and strict enforcement of prescribers’ adherence to the standard treatment guideline is highly recommended